<div style="width: 296px;
border: 2px solid #cecfce; 
text-align:center;
background-color: #eee;">
<a target="_parent" href="http://repsheet.com/"><img src="http://repsheet.com/media/img/logos/replogo_169w_eee.gif" style="
border:none; margin: 0; padding: 10px 10px 7px 10px;" /></a>
<p style="font-size:12px;font-weight:bold;font-family:arial,verdana,georgia;
margin: 0; padding: 0; ">Look up your elected representatives in Chicago.</p>
<form action="http://repsheet.com/" type="get" target="_parent"> 
    <input type="text" name="location" 
    style="margin: 5px 0; font-size: 12px; width: 230px; color: #bbb;" 
    value="Chicago street address or Zip code" 
    onfocus="if (this.value==this.defaultValue) { 
    this.value=''; this.style.color='#000'; }" 
    onblur="if (this.value=='') { 
    this.value=this.defaultValue; this.style.color='#bbb'; }" /> 
    <input type="submit" name="submit" value="Go" 
    style="font-size: 15px; margin: 0; width: 50px;" />
    <p style="font-size:12px; margin: 0;font-family:arial,verdana,georgia; padding: 0;"><a 
    style="text-decoration: none;" 
    href="http://repsheet.com" target="_parent" >Powered by RepSheet.com</a></p>
</form>
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